📌 Start simple. For low-risk discomfort, ECG + basic labs first; imaging follows if risk rises or symptoms persist.
Study | Typical insurer criteria | Why it matters | Notes & prep |
Coronary artery calcium (CAC) score CT | Age 40-75 with intermediate CAD risk | Quantifies plaque burden; guides statin use. | No IV dye; low dose; cash/self-pay. |
Resting echocardiogram | Murmur, dyspnea, known HF, valve disease | Ultrasound of heart size, valves, pumping strength. | No radiation; no pre-auth. |
Exercise treadmill ECG | Suspected effort-induced angina, able to exercise | Detects ischemia under stress. | Stop β-blockers; sneakers! |
Nuclear stress test (SPECT/PET) | Intermediate/high CAD risk, abnormal treadmill | Shows perfusion defects; risk stratifies. | IV tracer; moderate dose; auth. |
CTA coronary (CTCA) | Atypical chest pain, low–intermediate risk | Visualizes coronary arteries non-invasively. | IV dye; β-blocker prep; auth. |
Cardiac MRI | Cardiomyopathy, myocarditis, scar quantification | Gold for tissue characterization without radiation. | 45 min+; auth required. |
Sequence (general)
ECG, labs ⇒ risk stratify.
CAC score to refine preventive meds.
Stress test (treadmill ± isotope) if exertional symptoms.
CTCA or invasive angio if stress abnormal or high suspicion.
📌 Red-flags: crushing chest pain, syncope, severe SOB—call 911.